A Road of Retinal Detachments from Mayan Ruins to New Orleans

BROBSON LUTZ, M.D.

Dr. Robert Travis Kenny

BRIAN GAUVIN PHOTOGRAPH

We were standing in the back of a mini-truck bouncing over bad roads. I was worried about Dick, a 75-year-old professor scheduled for spinal stenosis surgery a month later. But I ended up the victim,” says New Orleans physician and frequent world traveler Dr. Robert Travis Kenny.

The primitive road that Kenny describes could’ve been Iberville or Bienville in downtown New Orleans, but he was far from the potholed streets we call home. He was one of 16 diverse travelers on an Overseas Adventure Travel tour last December to visit Mayan ruins. The timing of their trip coincided with the every 400 year flip of the Mayan calender.

“After about 45 minutes I started to notice a little blurry vision in the bottom of my left eye. First I thought it was a fleck of road dust. When it didn’t go away, I told the guide I wanted to see an ophthalmologist. He dropped me off in downtown Antigua and pointed in the direction of a medical office. The office was closed. We found another nearby ophthalmologist’s office and again, no doctor.”

He continues, “By this time, being a doctor, I was sure I was having a retinal detachment. I knew if I didn’t get laser (surgery) quickly, I would go blind. First it was just my peripheral vision. I couldn’t see my feet. By 2 p.m., I couldn’t see a chair. Fortunately, I had a friend in Guatemala who speaks fluent Spanish and English. I called him, and he drove right over to my hotel. He suggested we go to Guatemala City, about 45 minutes away.

“By late that afternoon I was in the office of a retinal specialist,” Kenny says. “By now I could only see the ceiling with my left eye. Dr. Jeffrey Singer, my ophthalmologist from New Orleans, called while the specialist was examining me, which was reassuring. My older brother also called. He had had similar surgery and asked if I had the best surgeon in Guatemala, like I was in a position to doctor shop.”

Kenny’s surgery was scheduled for 7:30 a.m. the next morning. “I had passed the stage for a simple laser repair and needed what’s called a sclera buckle procedure to pin down the retina,” Kenny says.

“He incised three of my four eye muscles, removed the eye, put in a backing called the buckle, reattached the eye, injected a gas bubble to flatten the retina, lasered things shut and reattached the lens.

When I awoke after the two-hour procedure, the surgeon said the operation was a complete success. He didn’t expect any vision loss, but I couldn’t fly or travel until things healed.”

Kenny dropped out of the tour, settled into a Best Western in Guatemala City and ventured out only to see the retinal specialist for eye checks every few days. After two weeks he was given the green light to fly home.

“I was so happy. I was finally going home,” Kenny says. “The plane flight was only 3.5 hours to Miami. But the last 45 minutes was the Spanish inquisition. As we descended, the pain became very severe. I was crying, hoping I would die. The other passengers cleared the way so I was first off the plane. I had problems decompressing after a flight years ago and assumed the swelling from surgery was causing the problem. I couldn’t hear. But I remembered I had Afrin decongestant spray in my bag. Dr. Ray Lousteau once told me to lie down, suck back on the Afrin and turn my head toward the ear tube to open it. I was flat on the carpet with people walking by, looking like a crazy man with Afrin spray. But I was 50 percent better in a few minutes. I cleared customs half blind and near deaf after the flight.”

Kenny’s sister and her husband, who live in Pompano Beach, met him at the airport. They arranged a next-day appointment for him to see a retinal specialist they knew.

“He told me I should never have flown, that the surgeon in Guatemala shouldn’t have let me fly for two months and I was probably going to be blind in my left eye. My brothers and sisters and I were all convinced that our sainted mother, a devote Catholic, would restore my vision through the Blessed Mary. The next day I could read my watch with my left eye for the first time. I was elated! The pain was gone.”

He continues, “The following day a friend drove me to my beach house in Pensacola (Fla.). But at 1:30 in the morning I woke up in pain again, not a severe pain, but I wanted to go home to New Orleans.

Dr. Singer arranged for me to see Dr. Brandon Davis, a highly respected retinal specialist. Dr. Davis also said I had flown too soon. Apparently, the gas bubble injected into my eyeball during the surgery in Guatemala had expanded on the airplane during descent. I needed additional laser therapy to tack back more pieces of tattered and displaced retina.”

“Dr. Davis told me I should only feel a warm sensation,” he continues. “The first 30 seconds I was OK. But then the pain became unbearable and kept me from holding my eye in position. I was praying to God. I remembered the torture methods used during the Spanish inquisition by the Jesuits and apologized profusely. Dr. Davis used clamps to keep my eye open. It was over in 10 minutes. My vision still isn’t perfect but it’s getting better with time.”

Kenny put all his medical charges in Guatemala on his American Express card. He hadn’t purchased additional travel insurance for his trip as his Blue Cross coverage was supposed to reimburse holders for emergency care anywhere in the world.

“The surgery in Guatemala that cost me $3,000 there would have cost over $20,000 here,” Kenny says. “Blue Cross got even a better deal. They still haven’t reimbursed me.”

Retinal detachment on a New Orleans weekend

Retinal holes, tears and detachments occur with age-related thinning of the retina. Retinal detachments are painless, but symptoms such as the new appearance of “floaters” or sudden small flashes of light often occur before the curtain of detachment falls, causing a full or partial visual field blackout.

Risk factors include a positive family history and prior cataract surgery. Trauma can also cause a tear. Sometimes the actual detachment doesn’t take place until weeks or months after the trauma, according to Dr. Jay Turkewitz, a neurologist formerly with LSU who now practices in Tennessee. This is exactly what happened to Edwin Curry just after he and some 200 other employees were laid off from The Times-Picayune.

“I took quite a jolt when my Subaru Forester was rear-ended by a van on Metairie Road the day before Hurricane Isaac last fall,” says Curry. “It cost several thousand to fix my car. My neck and back pains came on quickly, but my retinal problem took longer to become apparent.”

Curry was in New Orleans but his quest for proper medical care was akin to what Kenny experienced in Guatemala. His symptoms started on a weekend and were complicated by insurance confusions. He was routed from one Uptown ER to Ochsner on Jefferson Highway. In spite of a progressive increase in visual field loss from a small crescent moon to a quarter moon, the resident physician who examined him didn’t realize the time sensitivity of his problem.

Fortunately Curry had the foresight to see an ophthalmologist the next day who arranged for an emergency evaluation by Dr. Brandon Davis, the same retinal specialist who treated Kenny. Davis took Curry directly to surgery for a laser repair and told him further delay would’ve meant permanent vision loss. There is a common thread uniting Guatemala and New Orleans in these two eye tales: holidays and weekends aren’t good times for eye emergencies, as ophthalmology coverage in emergency rooms is often less than optimal.